The diabetes drug canagliflozin has been found to significantly lower the risk of kidney failure and cardiovascular problems in type 2 diabetes, a study reports. Canagliflozin is a SGLT2 inhibitor, marketed as Invokana, which works by allowing the kidneys to lower blood glucose levels, with excess glucose in the blood removed from the body through urine. In this new international study the drug lowered the risk of end-stage kidney disease by 32%. It also reduced the likelihood of renal (kidney) death by 34% as well as leading to 22 fewer emergency hospital admissions for heart failure and 25 less events involving cardiovascular death, heart attack or stroke per 1,000 people. The study involved tracking 4,401 people who had type 2 diabetes and chronic kidney disease from 34 countries. They were divided into two groups, with one given the drug and the other given a placebo, and followed up three times between March 2014 and May 2017. The drug has previously been found to lead to a higher chance of a lower limb amputation as a side effect, but this new research suggested there was no such increased risk. Additionally, rates of bone fracture were also the same between the two groups. However, the risk of diabetic ketoacidosis (DKA), a dangerous short-term complication of diabetes which can be fatal if not urgently treated, was found to be higher in the participants taking canagliflozin. Limitations of the study included not studying people with advanced kidney disease and also people who had kidney conditions not linked to type 2 diabetes. The research has been published in the New England Journal of Medicine.